| NPI | 1912292954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN26576) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA DNCS000513) |
| 1223G0001X Dentist General Practice (Licence: GA DNF000377) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2023-10-04 |