| NPI | 1720782006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7623) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN10000523) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2024-08-22 |