| NPI | 1255316758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 21081) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 7184) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2015-09-23 |