| NPI | 1043392111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL 14284) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN 14284) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2021-09-29 |