| NPI | 1366429169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN015033) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PR 1798) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2016-04-05 |