| NPI | 1588844476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN16251) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 10519) |
| 1223G0001X Dentist, General Practice (Licence: MA DN18586) | |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2022-06-24 |