| NPI | 1235811431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN2000306) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 18169) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-09-29 |