| NPI | 1952460180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN2248) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 3829) |
| 1223G0001X Dentist, General Practice (Licence: FL DN10233) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-07-08 |