| NPI | 1891027181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN 19187) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19187) |
| 122300000X Dentist (Licence: GA DN014030) | |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2013-09-27 |