| NPI | 1093466211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN14647) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL DN14647) |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2024-01-10 |