| NPI | 1598956534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122518) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 03836) |
| 1223G0001X Dentist, General Practice (Licence: CT 009756) | |
| 1223G0001X Dentist, General Practice (Licence: SC 4699) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2023-01-26 |