| NPI | 1932115102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: GA DN010757) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN010757) |
| 1223G0001X Dentist General Practice (Licence: GA DN010757) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-08-04 |