| NPI | 1497448690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10508) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 10508) |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2024-12-11 |