| NPI | 1710473681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34898) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN23519) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2022-09-12 |