| NPI | 1679295992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2024003502) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7704) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2024-12-02 |