| NPI | 1588725816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 8914) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN8914) |
| 1223G0001X Dentist, General Practice (Licence: FL 8914) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2018-06-07 |