| NPI | 1649422163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 7502) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 13225) |
| 122300000X Dentist (Licence: FL 3473) | |
| 122300000X Dentist (Licence: FL 11046) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2008-10-15 |