| NPI | 1427942929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12958) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 41478) |
| Enumeration Date | 2025-06-07 |
| Last Update Date | 2026-07-16 |