| NPI | 1811450232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN29594) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6978) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2025-01-11 |