| NPI | 1083275820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN28626) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11366) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2024-12-01 |