| NPI | 1083220503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26706) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600715) |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2022-06-12 |