| NPI | 1265460414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 6371) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 15660) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2008-06-16 |