| NPI | 1225503998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26447) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001953-15) |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2022-10-21 |