| NPI | 1407136807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17149) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D8652) |
| 1223G0001X Dentist, General Practice (Licence: ID d4398) | |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2015-06-19 |