| NPI | 1285310813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123691) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 108894) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2025-09-16 |