| NPI | 1457580185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 19693) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DPR 805) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2012-07-16 |