| NPI | 1083624183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN20530) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 1850) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-06-23 |