| NPI | 1083978266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122546) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19740) |
| 1223G0001X Dentist, General Practice (Licence: FL DN19740) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2021-12-29 |