| NPI | 1386172708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 10391483-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 10391483-9922) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2023-08-07 |