| NPI | 1730230046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 2500) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 2654) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2023-09-06 |