| NPI | 1285630376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN12272) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 841) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2013-02-25 |