| NPI | 1972624880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22833) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22833) |
| 1223G0001X Dentist, General Practice (Licence: NC 13569) | |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00205860) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2024-02-05 |