| NPI | 1831750561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9384) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2021-07-30 |