| NPI | 1760222400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NM DB-2024-0153) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DB-2024-0153) |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-06-26 |