| NPI | 1639424245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN25465) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD2719) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2020-09-24 |