| NPI | 1023337094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN014085) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN014085) |
| 1223G0001X Dentist, General Practice (Licence: PA DS038623) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS038623) | |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2020-07-10 |