| NPI | 1881047132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN 22156) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22156) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2024-04-28 |