| NPI | 1982834925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 18697) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3395) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2014-11-07 |