| NPI | 1902324593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN23062) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D009863) |
| Enumeration Date | 2017-09-02 |
| Last Update Date | 2021-03-08 |