| NPI | 1386823557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN18074) |
| Additional Taxonomies | 122400000X Denturist (Licence: FL DN18074) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2010-01-20 |