| NPI | 1841603602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2014016851) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61104) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2023-04-28 |