| NPI | 1518016625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 13045) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 10468) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2013-11-21 |