| NPI | 1518471788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34521) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX ETN462) |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2024-05-11 |