| NPI | 1841376266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN6047) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 6047) |
| 1223G0001X Dentist, General Practice (Licence: TX 18549) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN008052) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2012-04-23 |