| NPI | 1275602757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 9136) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN16603) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2013-04-03 |