| NPI | 1821254004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN12059) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN12059) |
| 1223P0300X Dentist, Periodontics (Licence: FL DN12059) | |
| 1223P0700X Dentist, Prosthodontics (Licence: FL DN12059) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN12059) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN12059) | |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2008-08-06 |