| NPI | 1386485944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 6001468-15) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN D15078) |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2024-06-05 |