| NPI | 1508411372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26433) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35368) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2021-09-13 |