| NPI | 1881904258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 29584) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 29584) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 29584) | |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2023-01-03 |