| NPI | 1225627532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN25773) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.032978) |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-04-15 |