| NPI | 1720294580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN10547) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS019544L) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2025-09-11 |