| NPI | 1518183870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19460) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3235-02) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2012-01-27 |