| NPI | 1235210303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013634) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: GA DPH000003) |
| 1223G0001X Dentist, General Practice (Licence: NC 8209) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-08-21 |