| NPI | 1063871804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN21896) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN21896) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2021-06-02 |