| NPI | 1649256108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014194) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401410916) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2016-11-16 |