| NPI | 1275712697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA dn013608) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 4397) |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2008-03-25 |