| NPI | 1952586471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN17893) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412008) |
| 122300000X Dentist (Licence: NC 150590) | |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2013-04-25 |