| NPI | 1477719086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17450) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052722-1) |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2008-08-13 |