| NPI | 1558835280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2021010387) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61780) |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2022-01-27 |