| NPI | 1740349612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN18897) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013458) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2015-11-08 |