| NPI | 1720391071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 10690) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19179) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2015-03-02 |