| NPI | 1568475226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 13298) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 130910351) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2017-02-23 |