| NPI | 1093374795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN122990) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 11414) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2025-04-17 |