| NPI | 1811243199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29711) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6439) |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 29711) | |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2023-03-13 |