| NPI | 1891917688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17317) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN71737) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-03-14 |