| NPI | 1790794550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 323051-9922) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 323051-6009) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2022-02-02 |