| NPI | 1932724218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 39647) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AL 6975) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2023-08-24 |