| NPI | 1851418289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35074) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 3663) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2024-02-01 |