| NPI | 1619386208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1000982-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1000982) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2025-04-15 |