| NPI | 1316034218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9891) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN8102) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2014-10-22 |