| NPI | 1124375647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN21055) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DRP1100) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2015-01-24 |