| NPI | 1174184741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-5054) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5054) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2023-08-07 |