| NPI | 1346322716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26586) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SD M847) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2024-11-06 |