| NPI | 1245377639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DTP772) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN122650) |
| 1223G0001X Dentist, General Practice (Licence: NH 3354) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2023-11-29 |