| NPI | 1326048620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015248) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 28298) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2022-06-03 |