| NPI | 1205452786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN016143) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 00000052) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2022-01-03 |