| NPI | 1942436217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014285) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8789) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2011-08-01 |