| NPI | 1750734703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11722) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22099) |
| 122300000X Dentist (Licence: OR D11722) | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2023-01-12 |