| NPI | 1417203274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 7031) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7031) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2024-07-15 |