| NPI | 1134109317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN11471) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 4945-015) |
| Enumeration Date | 2006-01-22 |
| Last Update Date | 2007-07-08 |