| NPI | 1194974667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10716) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8687) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2025-09-10 |