| NPI | 1013385327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC DGD.8801) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN015076) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2023-10-24 |