| NPI | 1902474489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2021021146) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901601576) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2023-03-30 |