| NPI | 1962140327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12719) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 12719) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2024-06-25 |