| NPI | 1992329833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD5698) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME DEN4804) |
| Enumeration Date | 2020-06-06 |
| Last Update Date | 2023-10-17 |