| NPI | 1891808119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 16808) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN012956) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-07-08 |