| NPI | 1942619986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN 20827) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 20827) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2016-02-27 |