| NPI | 1134173578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DNF000246) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN9605) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2023-04-13 |