| NPI | 1285284695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 24606) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 04518) |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2021-07-27 |