| NPI | 1033788096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122380) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.9965) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2025-06-28 |