| NPI | 1730244948 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 08391) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 6513) |
| 1223D0001X Dentist, Dental Public Health (Licence: FL DN18413) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2016-02-18 |