| NPI | 1003659525 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD.10849) | 
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL D.007345-C1) | 
| Enumeration Date | 2024-06-13 | 
| Last Update Date | 2025-07-14 |