| NPI | 1609386259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 112) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 29443) |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2024-08-15 |