| NPI | 1396398673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11264) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 9454) |
| 122300000X Dentist (Licence: OR D11264) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2021-08-13 |