| NPI | 1811166838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19549) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL 19249) |
| Enumeration Date | 2008-02-23 |
| Last Update Date | 2022-07-21 |