| NPI | 1609319185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10984) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 4894) |
| 1223G0001X Dentist, General Practice (Licence: LA 4894) | |
| Enumeration Date | 2016-12-01 |
| Last Update Date | 2025-09-15 |