| NPI | 1679775803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DTP483) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: FL DTP483) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2007-08-08 |