| NPI | 1295117729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC SC8570) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8570) |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2025-10-03 |