| NPI | 1770065435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 12475) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 0199) |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2024-09-11 |