| NPI | 1912379926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN21484) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D009321) |
| 1223G0001X Dentist, General Practice (Licence: FL DN21484) | |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2018-10-18 |