| NPI | 1952643363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN20254) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413906) |
| 122300000X Dentist (Licence: FL DN20254) | |
| Enumeration Date | 2013-03-24 |
| Last Update Date | 2020-12-15 |