| NPI | 1265402432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013649) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS031571L) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2015-03-31 |