| NPI | 1245837038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011358) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2020029968) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2022-07-22 |