| NPI | 1538237912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN 18556) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21689) |
| 1223G0001X Dentist, General Practice (Licence: FL DN 18556) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2016-10-19 |