| NPI | 1932849486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2025004676) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DRPM2407) |
| 1223G0001X Dentist, General Practice (Licence: FL DN28976) | |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2025-03-17 |