| NPI | 1144667080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DRPM2509) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 28888) |
| Enumeration Date | 2013-06-02 |
| Last Update Date | 2022-07-28 |