| NPI | 1740776335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN d14330) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001886-15) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2021-12-05 |