| NPI | 1164097531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SD d1382) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-5276) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2022-12-05 |