| NPI | 1760976997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40817) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D010065) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2024-07-29 |