| NPI | 1770101792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN25706) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401416966) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2023-04-07 |