| NPI | 1730384793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 19168) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 4306) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2012-11-20 |