| NPI | 1891925657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10273) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN014820) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2016-07-25 |