| NPI | 1184684615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN7364) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS019130L) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2019-09-09 |