| NPI | 1285947036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 20774) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7712229-9921) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2014-07-31 |