| NPI | 1659587715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN18368) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA dn013432) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2010-03-17 |