| NPI | 1346970613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10463) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2022020817) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2023-05-16 |