| NPI | 1083307110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13980) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 13436101-9922) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2024-09-23 |