| NPI | 1346814092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122656) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL D-0006948-C1) |
| 1223G0001X Dentist, General Practice (Licence: LA 7212) | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2022-10-04 |