| NPI | 1215422498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 9288) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN23379) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2022-03-15 |