| NPI | 1669963393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN27598) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS0000011068) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2022-12-19 |