| NPI | 1285713263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 6377731) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN0011082) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2019-07-30 |