| NPI | 1619997681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122400000X Denturist (Licence: FL DN14255) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN14255) |
| 1223G0001X Dentist, General Practice (Licence: FL DN14255) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2023-04-05 |