| NPI | 1497378137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 24874) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 4432) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2024-07-23 |