| NPI | 1457420101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN21669) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS020643L) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-03-10 |