| NPI | 1013279462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014401) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 7098) |
| 1223G0001X Dentist, General Practice (Licence: MA DN21393) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2021-09-14 |