| NPI | 1144512146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8554) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN014116) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2021-05-21 |