| NPI | 1780785063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014993) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA 0401008070) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-06-08 |