| NPI | 1730479288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD.8063 GD) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014260) |
| Enumeration Date | 2011-04-17 |
| Last Update Date | 2018-08-28 |