| NPI | 1447742358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5554) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY S15-692-135) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2023-08-08 |