| NPI | 1366336414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 14648) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN30354) |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2026-08-26 |