| NPI | 1740379460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN16593) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH18736) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2008-04-10 |