| NPI | 1255412953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN13544) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN0013544) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2018-09-26 |