| NPI | 1821472697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015623) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401415555) |
| 1223G0001X Dentist, General Practice (Licence: TX 33569) | |
| 1223G0001X Dentist, General Practice (Licence: PA DS041457) | |
| 1223G0001X Dentist, General Practice (Licence: IA 09462) | |
| 1223G0001X Dentist, General Practice (Licence: CT 12231) | |
| Enumeration Date | 2015-07-12 |
| Last Update Date | 2023-04-13 |