| NPI | 1871044107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122932) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34995) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2023-08-07 |