| NPI | 1124861752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN29082) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DRPM2765) |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2024-06-13 |