| NPI | 1386871747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN014237) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014237) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2020-09-18 |