| NPI | 1609567486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AR 4661) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4661) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2023-05-15 |