| NPI | 1528638186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 37368) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 11815) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2025-10-03 |