| NPI | 1205027968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN20768) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54522) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2015-02-09 |