| NPI | 1679267116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2024038491) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7910) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2024-10-02 |