| NPI | 1760912877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 10215) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN015438) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2022-07-21 |