| NPI | 1477122786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2023013422) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61882) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2025-04-14 |