| NPI | 1942441563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2022003092) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.031894) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2022-06-17 |