| NPI | 1750015665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 7861) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 10213) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2022-08-29 |