| NPI | 1093142432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015091) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN015091) |
| 122300000X Dentist (Licence: PA DS039750) | |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2024-12-17 |