| NPI | 1871607309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014667) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D6688) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2013-09-19 |