| NPI | 1386687101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN10249) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 8410) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2016-08-20 |