| NPI | 1407460942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 4671) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN016106) |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2024-05-22 |