| NPI | 1891742714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN008274) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4186) |
| 122300000X Dentist (Licence: NC 4002) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2021-10-22 |