| NPI | 1558918722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6001317-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7024) |
| 122300000X Dentist (Licence: TX 38070) | |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2023-07-27 |