| NPI | 1710409834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD.8945GD) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 10921) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2025-02-04 |