| NPI | 1770263113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 13368319-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 13368319-8903) |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2023-07-20 |