| NPI | 1851020721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 600136215) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IN 12013788A) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2024-01-09 |