| NPI | 1538416938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: GA DN014459) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA DN014459) |
| 122300000X Dentist (Licence: GA DN014459) | |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2016-06-03 |