| NPI | 1629465513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32439) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 32429) |
| Enumeration Date | 2015-04-19 |
| Last Update Date | 2022-01-25 |