| NPI | 1841853710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN28719) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11336306-8903) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2024-03-07 |