| NPI | 1376994236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 22032) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22032) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2019-10-19 |