| NPI | 1629831466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 41307) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN10000467) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2025-06-06 |