| NPI | 1629119466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015037) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411477) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2019-01-17 |