| NPI | 1740925916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN27808) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043979) |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2023-07-17 |