| NPI | 1669049821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10270) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN122359) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2023-05-03 |