| NPI | 1457701914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DTP784) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DTP636) |
| 1223G0001X Dentist, General Practice (Licence: FL DTP636) | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2023-06-21 |