| NPI | 1730132465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014599) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: GA 4053) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2013-09-06 |