| NPI | 1720823123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WY 1677) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 14055900-9926) |
| Enumeration Date | 2024-06-27 |
| Last Update Date | 2024-07-07 |