| NPI | 1346694924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 6308 C1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 6308) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2022-09-28 |