| NPI | 1144950445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2024048189) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D011380) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2024-12-13 |