| NPI | 1356742498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2025034587) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR AR4413) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2026-04-13 |