| NPI | 1689151508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34296) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11987) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2025-08-20 |