| NPI | 1366553976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN13683) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 11129) |
| 122300000X Dentist (Licence: GA DN011129) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-02-26 |