| NPI | 1629702428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 13926418-9923) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7672) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2024-06-25 |