| NPI | 1568001303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN30761) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61533) |
| Enumeration Date | 2019-12-26 |
| Last Update Date | 2025-08-07 |