| NPI | 1700444254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9371) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 9371) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2023-11-01 |