| NPI | 1265043756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN29180) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10493) |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2024-11-05 |