| NPI | 1871222497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1638) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5419) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2024-08-27 |