| NPI | 1134413248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12513) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19344) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2022-06-23 |