| NPI | 1821183419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN13684) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 13684) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-05-23 |