| NPI | 1225652449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7596) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7665) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2024-08-02 |