| NPI | 1275849986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN016137) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59547) |
| 1223G0001X Dentist, General Practice (Licence: TX 0025983) | |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2026-04-19 |