| NPI | 1689160483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24010) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2018023501) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2020-02-28 |