| NPI | 1972070829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 9586) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 10959097-9921) |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2021-10-27 |