| NPI | 1790347185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN122634) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7033) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2022-10-19 |