| NPI | 1679974224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122207) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN 20894) |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2021-02-09 |