| NPI | 1003424920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123359) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36323) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2024-07-14 |