| NPI | 1679003156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10943) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 9729) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2024-11-15 |