| NPI | 1992960116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D4080) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2358) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2024-03-18 |