| NPI | 1821152232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19400) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 2434) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2023-06-19 |