| NPI | 1376598243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA 11091) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN11091) |
| 1223G0001X Dentist, General Practice (Licence: GA DN011091) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2023-08-14 |