| NPI | 1245472802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN 18277) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 6350-015) |
| Enumeration Date | 2009-03-28 |
| Last Update Date | 2010-08-17 |