| NPI | 1306541305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123946) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2023021406) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2025-10-13 |