| NPI | 1578632964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4265) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013429) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2013-01-11 |