| NPI | 1982287892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11788) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 21493) |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2023-06-30 |