| NPI | 1588194658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34955) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22726) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2021-08-26 |