| NPI | 1689718157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN015578) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008783) |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2020-07-27 |