| NPI | 1578134193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN122740) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 12337263-8903) |
| 122300000X Dentist (Licence: UT 12337263-8903) | |
| 122300000X Dentist (Licence: UT 12337263-9921) | |
| 1223G0001X Dentist, General Practice (Licence: UT 12337263-9921) | |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2023-03-14 |