| NPI | 1457827859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12604) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001958-15) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2023-12-13 |