| NPI | 1013903996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN27318) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 02586) |
| 1223G0001X Dentist, General Practice (Licence: FL DTC18) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2023-02-14 |