| NPI | 1073184255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 26333) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN26870) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2021-07-20 |