| NPI | 1376053595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN22992) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN22992) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2025-03-13 |