| NPI | 1396240875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN25579) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2952000740) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-08-22 |