| NPI | 1598887838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 22621) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 009879) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2022-01-17 |