| NPI | 1518482363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN22988) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 101826) |
| Enumeration Date | 2017-08-12 |
| Last Update Date | 2017-08-12 |