| NPI | 1528131919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DTP697) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 1937) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2020-06-03 |