| NPI | 1679191795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2022014574) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 7347) |
| 122300000X Dentist (Licence: KS 61778) | |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2024-03-27 |