| NPI | 1700064813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 5703) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 5703) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2010-08-13 |