| NPI | 1457425787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN17207) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8140) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2022-04-01 |