| NPI | 1700825809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN18434) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS036341) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2019-04-29 |