| NPI | 1083274021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC DGD9873) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA DN1858327) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2022-08-02 |