| NPI | 1356317465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9689) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 9977) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2024-09-20 |