| NPI | 1891437596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DB-2023-0103) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV LL57522) |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2023-07-13 |