| NPI | 1316954027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN27633) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC SC3695) |
| 1223G0001X Dentist, General Practice (Licence: SC 3695) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2023-03-15 |