| NPI | 1023547536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10797) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4843) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-08-07 |