| NPI | 1619594868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2021026772) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK T-7346) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2021-10-08 |