| NPI | 1760078489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: TX 37184) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 37184) |
| 1223G0001X Dentist General Practice (Licence: TX 37184) | |
| Enumeration Date | 2020-12-16 |
| Last Update Date | 2023-12-17 |