| NPI | 1003877812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN17357) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA MA18745) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2011-07-22 |