| NPI | 1033229562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN12490) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS0000007478) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401102418) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN011634) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2011-06-29 |