| NPI | 1528625688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24627) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858282) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-06-09 |