| NPI | 1871232033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD.10174) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 13025) |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2022-10-13 |