| NPI | 1144415209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 19646) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411912) |
| 1223G0001X Dentist, General Practice (Licence: AZ 7699) | |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2012-02-24 |