| NPI | 1104983527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN31079) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 2903) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2025-11-11 |