| NPI | 1891356895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 13370975-9924) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35230) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2024-11-26 |