| NPI | 1477719961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 012353) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN25607) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2023-03-27 |