| NPI | 1033645171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN015412) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA FK4423199) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-08-21 |