| NPI | 1366583312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN13900) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL Dn 0013900) |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2022-02-10 |