| NPI | 1073928719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2014018841) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61273) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2021-01-15 |