| NPI | 1467199968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11765) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61927) |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2024-02-23 |