| NPI | 1164454575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN010591) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3031) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-03-26 |