| NPI | 1427258631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19532) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411922) |
| 1223G0001X Dentist, General Practice (Licence: WA DE00011239) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2011-12-15 |