| NPI | 1790931798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 126800000X Dental Assistant (Licence: GA DN013983) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7635) |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2010-11-02 |