| NPI | 1912168576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23020) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 23955) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2021-08-23 |