| NPI | 1619002979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL FL8179) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL FL28367) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2007-07-08 |