| NPI | 1801158597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32708) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035444) |
| Enumeration Date | 2012-06-09 |
| Last Update Date | 2025-07-24 |