| NPI | 1609258698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23837) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040493) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2019-11-06 |