| NPI | 1568675866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN19603) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 22136) |
| 122300000X Dentist (Licence: DC den5313) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2012-07-06 |