| NPI | 1396120002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN25354) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.8605 GD) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2020-09-16 |