| NPI | 1003293077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7115) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 38247) |
| 1223G0001X Dentist, General Practice (Licence: GA DN015106) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2023-12-19 |