| NPI | 1235925470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 14559) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 11133) |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2026-05-29 |