| NPI | 1982922506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013955) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 4679) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2010-07-21 |