| NPI | 1558950964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN122221) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN122221) |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2025-02-04 |