| NPI | 1831579457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL OS15033) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN21664) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2020-01-11 |