| NPI | 1851884258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5358) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 10858697-9922) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2022-03-17 |