| NPI | 1952889263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12167) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN015731) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2022-09-14 |