| NPI | 1487175634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 7373) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 09395) |
| 1223G0001X Dentist, General Practice (Licence: WI 101359-875) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2024-06-07 |