| NPI | 1508139890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA FP2954899) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014213) |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2024-09-09 |