| NPI | 1912975202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 010646) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 10646) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2015-07-13 |