| NPI | 1720242563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23754) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 22183) |
| 1223G0001X Dentist, General Practice (Licence: CT 010389) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2019-01-22 |