| NPI | 1710464953 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9487) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN015722) |
| 1223G0001X Dentist, General Practice (Licence: GA DN015722) | |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2019-09-23 |