| NPI | 1720422389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 260122) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 7039-15) |
| 1223G0001X Dentist General Practice (Licence: FL DN 20078) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2014-07-18 |