| NPI | 1699440701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 7763) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN26038) |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2021-08-11 |