| NPI | 1568819233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009458) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D009458) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2022-09-14 |