| NPI | 1043889462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 14647) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN26072) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2026-06-02 |