| NPI | 1942934344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6001024) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6001024-15) |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2024-11-07 |