| NPI | 1487697926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 9656) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN17246) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2015-12-22 |