| NPI | 1083736821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN016031) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS024091L) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2024-12-02 |