| NPI | 1679766927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI 2310) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN014035) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2018-06-24 |