| NPI | 1912510207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26577) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36589) |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2024-06-26 |