| NPI | 1649250663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123384) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401410541) |
| 1223G0001X Dentist, General Practice (Licence: FL DTC81) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2025-03-10 |