| NPI | 1528075231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: FL DN20545) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 007977) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2015-12-21 |