| NPI | 1821512765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 34980) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 10401448-9921) |
| 1223G0001X Dentist, General Practice (Licence: TX 34980) | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2024-05-30 |