| NPI | 1205586948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN29698) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859357) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2025-04-29 |