| NPI | 1164153235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IA DDS10165) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DDS10165) |
| 1223G0001X Dentist General Practice (Licence: FL DN27095) | |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2024-04-29 |