| NPI | 1497320048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MT 24482) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 7470) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2023-03-07 |