| NPI | 1982660064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 10524) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 10136) |
| 1223G0001X Dentist, General Practice (Licence: MO 16023) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2007-07-08 |