| NPI | 1801381892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11734) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8932591-9922) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2024-02-23 |