| NPI | 1871149120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN24508) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35798) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2023-08-28 |