| NPI | 1972970663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL dn28144) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64847) |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2023-12-13 |