| NPI | 1275142481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2020025301) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4450) |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2024-12-17 |