| NPI | 1053037234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 2023044154) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 107390) |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2024-11-12 |