| NPI | 1770782039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN-17786) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17786) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2020-04-09 |