| NPI | 1982897609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 18486) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411926) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2008-09-23 |