| NPI | 1366431462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DTP840) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10637) |
| 122300000X Dentist (Licence: NE 6475) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2025-02-12 |