| NPI | 1033807706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN29477) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: FL 20161052597) |
| 124Q00000X Dental Hygienist (Licence: FL DH28742) | |
| 1223G0001X Dentist, General Practice (Licence: FL 2536) | |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2026-02-11 |