| NPI | 1003517640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN31445) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 10000437) |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2026-07-27 |