| NPI | 1508423815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL dn28022) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 061205) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2024-07-15 |