| NPI | 1326502568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13653) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 11019) |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2025-09-25 |