| NPI | 1881610285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DM25660) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D7062) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2022-12-14 |