| NPI | 1245639319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 28941) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6513) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2025-08-18 |