| NPI | 1457589228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 20364) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027935) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2013-09-16 |