| NPI | 1669427837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN011110) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DNCS000131) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-04-13 |