| NPI | 1700830999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: GA DN012701) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN012701) |
| 1223G0001X Dentist General Practice (Licence: GA DN012701) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2024-12-06 |