| NPI | 1962924795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23216) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 059998) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2021-09-08 |