| NPI | 1932456084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29786) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19904) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2022-08-05 |