| NPI | 1508483850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2020018067) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7338) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2020-07-02 |