| NPI | 1710498050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 0000012124) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6955) |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2023-06-13 |