| NPI | 1881602324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2021019784) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 17917) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-05-24 |