| NPI | 1528497005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015777) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401414253) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2024-02-15 |