| NPI | 1700992021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 7540) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL FL7540) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2015-04-10 |