| NPI | 1346384880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN0013781) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS030510L) |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2007-07-08 |