| NPI | 1215541677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122542) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 4459) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2025-11-07 |