| NPI | 1457527632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013819) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY P60738) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2014-09-10 |