| NPI | 1710625405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 7906) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D011367) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2023-11-21 |