| NPI | 1326787193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13128) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 12852954-9922) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2023-03-08 |