| NPI | 1508553793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 13365962-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 13365962-8903) |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2023-04-19 |