| NPI | 1588305775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN29410) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401418710) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2024-07-17 |