| NPI | 1811370398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1002015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 21361) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2021-01-21 |