| NPI | 1932105087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 126800000X Dental Assistant |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 15877) |
| 124Q00000X Dental Hygienist (Licence: TX 427) | |
| 124Q00000X Dental Hygienist (Licence: TX 12440) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2025-09-11 |