| NPI | 1053328211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN12998) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 12998) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2018-05-02 |