| NPI | 1114509080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 12322243-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 12322243-8903) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2023-08-24 |