| NPI | 1720074479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27927) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO DE015921) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2024-07-15 |