| NPI | 1306224845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN21648) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6908) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2018-08-03 |