| NPI | 1407699945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2024044394) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 62129) |
| Enumeration Date | 2024-06-13 |
| Last Update Date | 2026-02-04 |