| NPI | 1215191564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 8384) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: GA 008384) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2017-01-23 |