| NPI | 1518050376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015888) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN14839) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-10-31 |