| NPI | 1730530874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 9497) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001737) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1001737) | |
| 1223G0001X Dentist, General Practice (Licence: VA 0401415302) | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2022-07-21 |