| NPI | 1568726347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN21541) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1855956) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2015-09-03 |