| NPI | 1376160010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN25009) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7968) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-01-15 |