| NPI | 1912491218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 35761) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD5079) |
| 1223G0001X Dentist, General Practice (Licence: TX 35761) | |
| 1223G0001X Dentist, General Practice (Licence: NM DD5079) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2022-10-24 |