| NPI | 1801021605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 27257) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 010037) |
| 1223G0001X Dentist, General Practice (Licence: CT 010037) | |
| 1223G0001X Dentist, General Practice (Licence: TX 27257) | |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2023-04-28 |