| NPI | 1568536258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39188) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 4787T) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2024-12-12 |