| NPI | 1609595925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38938) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 38938) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2025-11-10 |