| NPI | 1174705172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013810) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS018073L) |
| 1223G0001X Dentist, General Practice (Licence: SC 40) | |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2024-01-30 |