| NPI | 1689644635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN012784) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3991) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2023-09-05 |