| NPI | 1396766127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 3149) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA LA 3149) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2024-10-03 |