| NPI | 1467023622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13130) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9928) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2023-03-09 |