| NPI | 1487232294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN2000525) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 4364-23) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-08-03 |