| NPI | 1881032993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 25613) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 25613) |
| 122300000X Dentist (Licence: TX 28904) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2023-10-26 |