| NPI | 1689414922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401418990) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 18470) |
| Enumeration Date | 2024-05-24 |
| Last Update Date | 2024-11-24 |