| NPI | 1003582586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2022044503) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 62043) |
| 1223G0001X Dentist, General Practice (Licence: TX 37493) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2023-03-15 |