| NPI | 1245689728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123428) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 21873) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2025-03-21 |