| NPI | 1639693039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN22888) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401416296) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2022-07-21 |