| NPI | 1578862777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014101) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 6964) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2011-10-22 |