| NPI | 1013053487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19399) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 35537) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2011-07-06 |