| NPI | 1952044208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-5400) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: UT 12795233-9922) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2022-04-25 |