| NPI | 1629630306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 175448) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11349973-8903) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2022-10-04 |