| NPI | 1902417140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11289) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D11289) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2024-04-17 |