| NPI | 1548641707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31795) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10087) |
| Enumeration Date | 2015-06-13 |
| Last Update Date | 2021-11-05 |