| NPI | 1215165154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014892) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS037948) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2023-01-18 |