| NPI | 1033404819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20591) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: GA DNF000359) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2015-06-10 |