| NPI | 1750841862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17301) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD LL850) |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2021-04-12 |