| NPI | 1821725011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN122761) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 11944) |
| Enumeration Date | 2022-08-07 |
| Last Update Date | 2023-09-13 |