| NPI | 1710984471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 21610) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR D-02282) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-01-18 |