| NPI | 1740639798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2016018485) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61177) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2022-07-21 |