| NPI | 1982127718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 10443082-9926) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 10443082-9922) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2024-07-09 |