| NPI | 1811197460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4382) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 150632) |
| 1223G0001X Dentist, General Practice (Licence: GA DN015148) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2023-02-11 |