| NPI | 1790777183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DNF000407) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 2874) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2023-04-13 |