| NPI | 1346756533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 11068) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001729) |
| 1223G0001X Dentist, General Practice (Licence: TX 35896) | |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2025-05-13 |