| NPI | 1760089619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901601064) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 0006819-C1) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2021-08-27 |