| NPI | 1386026003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10334) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8558) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2021-05-14 |