| NPI | 1255317301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA BS3815) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 011885) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2020-08-19 |