| NPI | 1518691336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL D6942C1) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D00006942C1) |
| Enumeration Date | 2022-07-16 |
| Last Update Date | 2022-07-16 |