| NPI | 1154948867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10661) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 19337) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-02-04 |