| NPI | 1306007547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN20567) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL DN20567) |
| 1223P0700X Dentist, Prosthodontics (Licence: GA DN014325) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2022-01-05 |