| NPI | 1922175181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 17415) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 17415) |
| 122300000X Dentist (Licence: MI 2901017575) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2019-09-20 |