| NPI | 1043746084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2020005760) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001606-15) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2025-12-02 |