| NPI | 1427655901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 4494-25) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9724) |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2026-01-20 |