| NPI | 1073235719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 13031322-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 13031322-9922) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2023-06-26 |