| NPI | 1841803855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 10132) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 10132) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401417029) | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2023-03-09 |