| NPI | 1790970275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 34774) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34774) |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2026-02-06 |