| NPI | 1164591913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DNO12698) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 55514) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2022-02-21 |