| NPI | 1174194609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1002561-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1002561) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2024-08-19 |