| NPI | 1780744136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D11988) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 7143-15) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2024-07-15 |