| NPI | 1770277972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MO 2025024011) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7759) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2025-06-24 |