| NPI | 1487964961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413474) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6593-015) |
| 122300000X Dentist (Licence: VA 0401413474) | |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2026-07-31 |