| NPI | 1477237998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4828) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 4388-23) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2025-08-11 |