| NPI | 1033803812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2023021085) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 62092) |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2023-06-06 |