| NPI | 1861554057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23755) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 23755) |
| 1223G0001X Dentist, General Practice (Licence: PA DS035391) | |
| 1223G0001X Dentist, General Practice (Licence: NJ 22D102137400) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2022-01-12 |