| NPI | 1326779430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 7839) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA DDS-10006) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2024-03-14 |