| NPI | 1912199498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN21674) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 3165) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2024-04-10 |