| NPI | 1265952089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2018012854) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6970) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-07-21 |