| NPI | 1609914753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: FL DN 16239) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CO HD 1-00470) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2013-02-18 |