| NPI | 1235395807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013775) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN013775) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2016-02-10 |