| NPI | 1710188487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN14152) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 164574.0000) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2022-09-21 |