| NPI | 1528113289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 2946) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 33906) |
| 122300000X Dentist (Licence: AR 2946) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2026-04-06 |