| NPI | 1700077922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN011355) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: GA Dno11355) |
| 122300000X Dentist (Licence: GA Dno11355) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2024-11-18 |