| NPI | 1073250247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2022017694) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2022017964) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2023-09-13 |