| NPI | 1790390557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39469) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7381) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2023-06-25 |