| NPI | 1720566102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 6986-c1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2018026319) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2022-04-01 |