| NPI | 1386173276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 11176321-9924) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901022217) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2022-10-21 |