| NPI | 1033647383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 9467) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: SD D1150) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2023-02-27 |