| NPI | 1669968855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2018019126) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61461) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2022-10-12 |