| NPI | 1508384728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV LL-572-22) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 10399382-9922) |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2022-07-05 |