| NPI | 1932288610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN10392) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 52172) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2007-09-04 |