| NPI | 1720137490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015726) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 31127) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-08-18 |