| NPI | 1346591666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 10151) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 28194) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2022-12-01 |