| NPI | 1740890714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40064) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1002391) |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2024-12-11 |