| NPI | 1801809215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NE 6411) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6411) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2023-09-11 |