| NPI | 1669032694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D010356) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D14365) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2023-03-23 |