| NPI | 1710567177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122465) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D-0006952-C1) |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2021-08-18 |