| NPI | 1720322852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39533) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN23865) |
| 183500000X Pharmacist (Licence: SC 13654) | |
| 183500000X Pharmacist (Licence: GA 024929) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2025-03-19 |