| NPI | 1588600712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX D11932) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX D11932) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2025-09-11 |