| NPI | 1003277922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI DT2716) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10653) |
| Enumeration Date | 2016-03-19 |
| Last Update Date | 2021-03-28 |