| NPI | 1396703989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN8954) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12006816A) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2007-07-08 |