| NPI | 1881610855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN18188) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MS 3046-98) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-03-15 |