| NPI | 1396438792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2023019567) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7919) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2023-12-19 |