| NPI | 1881704559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN13001) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN0013001) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |