| NPI | 1942306469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD.8737) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN0011746) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2016-08-02 |