| NPI | 1891971776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN13329) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL dn13329) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2019-10-08 |