| NPI | 1609164987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN21926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 8037796-9921) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2017-05-03 |