| NPI | 1255818910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122240) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34420) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2023-09-06 |