| NPI | 1114300076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN21422) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN21422) |
| 122400000X Denturist (Licence: FL DN21422) | |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2015-07-09 |