| NPI | 1750649430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 25990) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6547) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2023-01-05 |