| NPI | 1952953234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 36110) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 11113) |
| 1223G0001X Dentist, General Practice (Licence: TX 36110) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2023-07-19 |