| NPI | 1528298379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD4663) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013910) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2020-12-29 |