| NPI | 1083124515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 008772) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 3386) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2017-10-11 |