| NPI | 1760535934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN18472) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA 036822) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2012-03-06 |