| NPI | 1215545827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 14524) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9675) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2026-05-02 |