| NPI | 1770151474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10249) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011064) |
| 1223G0001X Dentist, General Practice (Licence: NC 13000) | |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2024-12-03 |