| NPI | 1043745219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26008) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DRPM1991) |
| 1223G0001X Dentist, General Practice (Licence: FL DRPM1991) | |
| 124Q00000X Dental Hygienist (Licence: FL DH24451) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2021-07-22 |