| NPI | 1679058572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26273) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH24862) |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2021-09-24 |