| NPI | 1013975754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 8058) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 11912) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-10-13 |