| NPI | 1841429875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN18354) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8885) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2012-05-08 |