| NPI | 1003198680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015568) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TN 11292) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2024-02-14 |