| NPI | 1699978056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN16138) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN16138) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2023-08-18 |