| NPI | 1396357109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12560) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN25409) |
| 1223G0001X Dentist, General Practice (Licence: SC DGD.9717) | |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2022-02-14 |