| NPI | 1568781227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN15961) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL DN 15961) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2017-01-03 |