| NPI | 1043613268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 27639) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 11299) |
| 1223G0001X Dentist, General Practice (Licence: CT 11299) | |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2023-01-24 |