| NPI | 1548780281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122639) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN22740) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2022-05-17 |