| NPI | 1538206123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN18440) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME 3807) |
| 1223G0001X Dentist, General Practice (Licence: NH 3491) | |
| 1223G0001X Dentist, General Practice (Licence: FL DN18440) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2024-09-17 |