| NPI | 1245351352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013646) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17023) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2024-06-26 |