| NPI | 1134211709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 2489) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2208) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2025-07-17 |