| NPI | 1831507359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9517) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 109844) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2021-12-30 |