| NPI | 1992297071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011037) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SD D1187) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2024-01-23 |