| NPI | 1720430614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9237) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 10437) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2023-02-08 |