| NPI | 1548758147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23942) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11029) |
| Enumeration Date | 2018-04-29 |
| Last Update Date | 2020-04-21 |