| NPI | 1083247209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD.9871GD) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN016114) |
| Enumeration Date | 2020-02-17 |
| Last Update Date | 2022-05-10 |