| NPI | 1790246791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34915) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: TX 34915) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2020-05-18 |