| NPI | 1336210087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 8897) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 9366) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |