| NPI | 1740389147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DTP747) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS0000007645) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2021-10-27 |