| NPI | 1023116936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 4697) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7241) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2026-01-14 |