| NPI | 1023497385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014992) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA Applied for) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2018-03-17 |