| NPI | 1346348166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN13352) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL DN13352) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-01-17 |