| NPI | 1750397873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 10002) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NM 1980) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-07-20 |