| NPI | 1467114025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2022046428) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 09948) |
| Enumeration Date | 2021-10-12 |
| Last Update Date | 2023-01-18 |