| NPI | 1124702972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD.11015.GD) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 28114) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2025-02-03 |