| NPI | 1982626990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015352) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 27791) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-02-03 |