| NPI | 1982991261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30553) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 8024940-9922) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2020-03-26 |