| NPI | 1366180820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26853) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 26853) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2024-06-27 |