| NPI | 1316561566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2020020655) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61697) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2023-08-22 |