| NPI | 1871225680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10274) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: SC 10274) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2022-07-20 |