| NPI | 1508424243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 11997356-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD5098) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2023-01-16 |