| NPI | 1700136645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23848) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 32544) |
| 1223G0001X Dentist, General Practice (Licence: OR D9769) | |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2021-07-06 |