| NPI | 1073703708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN18049) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN18049) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2023-11-28 |