| NPI | 1205451754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 23622) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 7283) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2022-06-24 |