| NPI | 1538680053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39384) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN22858) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2024-05-13 |