| NPI | 1366591166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN009589) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN9316) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-03-23 |