| NPI | 1962980961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34909) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D010109) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2024-05-01 |