| NPI | 1003262940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 13496) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001584) |
| 122300000X Dentist (Licence: SC DGD.10229) | |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2023-10-03 |