| NPI | 1598380552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401418400) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5164) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2023-09-18 |