| NPI | 1033377130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 0011872) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL dn0011872) |
| 1223G0001X Dentist, General Practice (Licence: FL DN0011872) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2008-05-27 |