| NPI | 1851447247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN15038) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 011618) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN15038) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2018-08-20 |