| NPI | 1801341656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-4785) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D-4785) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2021-01-27 |