| NPI | 1902170228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36013) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: TX 36013) |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2023-01-04 |