| NPI | 1881716694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4187) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013289) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2017-06-06 |