| NPI | 1922098557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD2331) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21057) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2025-07-16 |