| NPI | 1164540407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN12464) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 10574) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2015-05-30 |