| NPI | 1679003768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 12192) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL 22703) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2021-11-26 |