| NPI | 1407415250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12667) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.032161) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2024-04-25 |