| NPI | 1134534266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015980) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 30188) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2021-09-02 |