| NPI | 1205268216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC DGD.8281 GD) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.8281 GD) |
| 122300000X Dentist (Licence: FL DN 20280) | |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2015-03-20 |