| NPI | 1871685800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN18420) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901018932) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2016-03-24 |