| NPI | 1124042783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8544) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN10234) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2014-03-28 |