| NPI | 1487062857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: FL DN22744) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 6127C1) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2022-07-21 |