| NPI | 1669503280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN18203) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00202974) |
| 122300000X Dentist (Licence: FL 18203) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2018-07-10 |