| NPI | 1912148552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24982) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24982) |
| 122300000X Dentist (Licence: CA 58095) | |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2024-06-13 |