| NPI | 1699796771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 012441) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN15883) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2018-05-02 |