| NPI | 1144385774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 7697) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN0007697) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2018-08-06 |