| NPI | 1194319368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26594) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 11749) |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2025-09-29 |