| NPI | 1013391119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015041) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC DGD.8645 GD) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2022-04-02 |