| NPI | 1912571472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12531) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 12197) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-11-21 |