| NPI | 1225340441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 891) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412844) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2010-07-02 |