| NPI | 1174906242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 20117002646) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 21412) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2023-08-23 |