| NPI | 1881925667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN14676) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN0014676) |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2021-04-08 |