| NPI | 1497897979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN14248) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D11595) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2025-10-16 |