| NPI | 1558927020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2021012610) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 7152) |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2024-03-13 |