| NPI | 1730303959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 7828) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 046784) |
| 1223G0001X Dentist General Practice (Licence: FL DNOO14422) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2022-05-03 |