| NPI | 1487819355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DNF000345) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: SC 2372) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2023-04-13 |