| NPI | 1841468659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN0013755) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 18415) |
| 122300000X Dentist (Licence: AL 4603) | |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-02-14 |