| NPI | 1346731122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 8264015-9926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2020025428) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2023-10-16 |