| NPI | 1316467483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10031) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11997) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-05-13 |