| NPI | 1164031662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9704) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 0000011819) |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2022-04-25 |