| NPI | 1558746974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015134) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN21377) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2017-11-17 |