| NPI | 1013694538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 7948) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI03049700) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2024-09-06 |