| NPI | 1760043079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN24245) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401416583) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2023-05-12 |