| NPI | 1649205014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN29875) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3352-05) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2025-05-21 |