| NPI | 1497905400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 37202) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22di02387800) |
| 1223G0001X Dentist, General Practice (Licence: TX 37202) | |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2025-06-02 |