| NPI | 1497061634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN19194) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D0005975-C1) |
| 1223G0001X Dentist, General Practice (Licence: FL DN 19194) | |
| 1223G0001X Dentist, General Practice (Licence: FL DN19194) | |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2022-09-29 |