| NPI | 1770358830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 41853) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 109471) |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2025-11-03 |