| NPI | 1831251867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013620) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12008101) |
| 122300000X Dentist (Licence: GA DN013620) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2012-11-28 |