| NPI | 1679549430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN012534) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401410997) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2019-08-14 |