| NPI | 1336357748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN17200) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN17200) |
| 1223G0001X Dentist, General Practice (Licence: FL DN17200) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2014-10-02 |