| NPI | 1528716388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 223042) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN27984) |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2024-06-21 |