| NPI | 1689175671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2019008419) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33723) |
| Enumeration Date | 2018-02-24 |
| Last Update Date | 2019-03-28 |