| NPI | 1942823661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11932) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN25461) |
| 1223G0001X Dentist, General Practice (Licence: MD 17850) | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2024-02-26 |