| NPI | 1033776158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10439) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11785942) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2024-06-14 |