| NPI | 1417997776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN010234) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: GA DN010234) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2011-02-03 |