| NPI | 1902964745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN10594) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL D2215) |
| 122300000X Dentist (Licence: FL DN2176) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |