| NPI | 1922443902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9510) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 10718) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2024-10-15 |