| NPI | 1700227980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014604) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN0146504) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2018-06-04 |