| NPI | 1922085331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 21480) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21480) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2023-03-07 |