| NPI | 1154858413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11656) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN23051) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2023-10-11 |