| NPI | 1821246729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013766) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR005434) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2022-01-04 |