| NPI | 1558473686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 4985) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013075) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-03-14 |