| NPI | 1801441852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1002170-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN24436) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2019-09-30 |