| NPI | 1841420536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28728) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS037918) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2024-11-07 |