| NPI | 1659683324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014133) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014133) |
| 122300000X Dentist (Licence: SC 6908) | |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2013-01-10 |