| NPI | 1740760842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: TX 34513) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34513) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2023-04-18 |