| NPI | 1922253467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN14993) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH2907) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2008-11-25 |