| NPI | 1043796873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2018014355) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61335) |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2025-01-15 |