| NPI | 1639280381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN13947) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 041836) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-05-31 |