| NPI | 1831823772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN29851) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 38673) |
| 1041C0700X Social Worker, Clinical (Licence: TX 38673) | |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2025-01-16 |