| NPI | 1043834997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D11230) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11230) |
| 122300000X Dentist (Licence: OR 11230) | |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2022-07-08 |