| NPI | 1790888733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 2015042811) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KS 6796) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2023-05-09 |