| NPI | 1760121586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D14744) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ND 2456) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2024-03-14 |