| NPI | 1184766545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19529) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412732) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-08-09 |