| NPI | 1467664128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 9079) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 4841) |
| 1223G0001X Dentist, General Practice (Licence: NC 4595) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2007-07-08 |