| NPI | 1831707785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7494) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401417053) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2023-11-15 |