| NPI | 1497774624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN15922) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH16330) |
| 124Q00000X Dental Hygienist (Licence: FL DH11475) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-05-20 |