| NPI | 1851319974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA GA12342) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA 012342) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2010-09-01 |