| NPI | 1225505704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN28140) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61513) |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2023-12-01 |