| NPI | 1053837807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9710) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN015509) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2023-01-10 |