| NPI | 1598017741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24846) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 62837) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2023-10-27 |