| NPI | 1811081441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: FL DN27396) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 15194) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-09-05 |