| NPI | 1053804658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10703) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34121) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2025-03-22 |